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Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/11471

Title: Atypical Subtrochanteric and Diaphyseal Femoral Fractures: Report of a Task Force of the American Society for Bone and Mineral Research
Authors: Shane, Elizabeth
Burr, David
Ebeling, Peter R.
Abrahamsen, Bo
Adler, Robert A.
Brown, Thomas D.
Cheung, Angela M.
Cosman, Felicia
Curtis, Jeffrey R.
Dell, Richard
Dempster, David
Einhorn, Thomas A.
Genant, Harry K.
GEUSENS, Piet
Klaushofer, Klaus
Koval, Kenneth
Lane, Joseph M.
McKiernan, Fergus
McKinney, Ross
Ng, Alvin
Nieves, Jeri
O'Keefe, Regis
Papapoulos, Socrates
Sen, Howe Tet
van der Meulen, Marjolein C. H.
Weinstein, Robert S.
Whyte, Michael
Issue Date: 2010
Publisher: JOHN WILEY & SONS INC
Citation: JOURNAL OF BONE AND MINERAL RESEARCH, 25(11). p. 2267-2294
Abstract: Reports linking long-term use of bisphosphonates (BPs) with atypical fractures of the femur led the leadership of the American Society for Bone and Mineral Research (ASBMR) to appoint a task force to address key questions related to this problem A multidisciplinary expert group reviewed pertinent published reports concerning atypical femur fractures, as well as preclinical studies that could provide insight into their pathogenesis A case definition was developed so that subsequent studies report on the same condition The task force defined major and minor features of complete and incomplete atypical femoral fractures and recommends that all major features including their location in the subtrochantenc region and femoral shaft transverse or short oblique orientation minimal or no associated trauma a medial spike when the fracture is complete and absence of comminution be present to designate a femoral fracture as atypical Minor features include their association with cortical thickening a periosteal reaction of the lateral cortex prodromal pain bilaterality delayed healing, comorbid conditions and concomitant drug exposures including BPs other antiresorptive agents, glucocorticoids, and proton pump inhibitors Preclinical data evaluating the effects of BPs on collagen cross-linking and maturation accumulation of microdamage and advanced glycation end products mineralization remodeling vascularity and angiogenesis lend biologic plausibility to a potential association with long-term BP use Based on published and unpublished data and the widespread use of BPs, the incidence of atypical femoral fractures associated with BP therapy for osteoporosis appears to be very low particularly compared with the number of vertebral hip and other fractures that are prevented by BPs Moreover a causal association between BPs and atypical fractures has not been established However recent observations suggest that the risk rises with increasing duration of exposure, and there is concern that lack of awareness and underreporting may mask the true incidence of the problem Given the relative rarity of atypical femoral fractures the task force recommends that specific diagnostic and procedural codes be created and that an international registry be established to facilitate studies of the clinical and genetic risk factors and optimal surgical and medical management of these fractures Physicians and patients should be made aware of the possibility of atypical femoral fractures and of the potential for bilaterality through a change in labeling of BPs Research directions should include development of animal models, increased surveillance and additional epidemiologic and clinical data to establish the true incidence of and risk factors for this condition and to inform orthopedic and medical management (C) 2010 American Society for Bone and Mineral Research
Notes: [Shane, Elizabeth] Columbia Univ Coll Phys & Surg, New York, NY 10032 USA. [Burr, David] Indiana Univ, Sch Med, Dept Anat & Cell Biol, Indianapolis, IN 46202 USA. [Abrahamsen, Bo] Univ Copenhagen, Gentofte Hosp, DK-1168 Copenhagen, Denmark. [Brown, Thomas D.] Univ Iowa, Iowa City, IA 52242 USA. [Cheung, Angela M.] Univ Toronto, Univ Hlth Network, Toronto, ON M5S 1A1, Canada. [Curtis, Jeffrey R.] Univ Alabama, Birmingham, W Midlands, England. [Dempster, David] Columbia Univ, New York, NY 10027 USA. [Ebeling, Peter R.] Univ Melbourne, Melbourne, Vic 3010, Australia. [Einhorn, Thomas A.] Boston Med Ctr, Boston, MA USA. [Genant, Harry K.] Univ Calif San Francisco, San Francisco, CA 94143 USA. [Geusens, Piet] Maastricht Univ, Med Ctr, Maastricht, Netherlands. [Geusens, Piet] Univ Hasselt, Diepenbeek, Belgium. [Klaushofer, Klaus] Hanusch Hosp, Ludwig Boltzmann Inst Osteol, Ludwigshafen, Germany. [Koval, Kenneth] Dartmouth Hitchcock Med Ctr, Dartmouth, NS, Canada. [McKinney, Ross] Duke Univ, Sch Med, Durham, NC 27706 USA. [Ng, Alvin] Singapore Gen Hosp, Singapore, Singapore. [O'Keefe, Regis] Univ Rochester, Rochester, NY 14627 USA. [Papapoulos, Socrates] Leiden Univ, Med Ctr, NL-2300 RA Leiden, Netherlands. [Sen, Howe Tet] Singapore Gen Hosp, Singapore, Singapore. [van der Meulen, Marjolein C. H.] Cornell Univ, Ithaca, NY 14853 USA. [Weinstein, Robert S.] Univ Arkansas Med Sci, Little Rock, AR 72205 USA.
URI: http://hdl.handle.net/1942/11471
DOI: 10.1002/jbmr.253
ISI #: 000284133500001
ISSN: 0884-0431
Category: A1
Type: Journal Contribution
Validation: ecoom, 2011
Appears in Collections: Research publications

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